Transcript Slide 1

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Confidential
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Copyright © 2014 TriZetto Corporation
QicLink™
EFT Processing
Susan Scardina – Sr QicLink Product Manager
Laura Gerling – Mgr of Product, Partner & Acct Mgmt
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Copyright © 2014 TriZetto Corporation
Agenda
 Purpose and Benefit
 Overview
 EFT Workflow Overview
 Setup
 Pre-Note Processing
 Electronic Fund Transfer
 ACH File Format
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Copyright © 2014 TriZetto Corporation
Purpose and Benefit
 Electronic Fund Transfer (EFT)
 Allow for electronic fund transfers (EFT) in the National
Automated Clearing House Association (NACHA) –
ACH file format
 Prearranged Payment and Deposit Entry (PPD)
 Benefit – Recipient payments directly
transferred to desired savings/checking
account in lieu of printed checks
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EFT Advantages to Participants
 Administrators
 Reduction of administration and operating expenses
 Reduction of costs for check account reconciliation
 Elimination of stop payment and check reissue costs
 Recipients
 Elimination in time and cost involved to deposit checks
 Consistent availability of funds
 Vacation
 Business trips
 Illness
 Elimination of lost or stolen checks
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NACHA Participants
 Originator
 Initiates ACH entries into payment system
 Originating Depository Financial Institution (ODFI)
 Receives payment instructions from Originator
 Forward entries to ACH Operator
 Automated Clearing House (ACH) Operator
 Central clearing facility
 Receiving Depository Financial Institution (RDFI)
 Receives and posts entries to participant (receiver) accounts
 Receiver
 Authorizes an Originator to initiate an ACH entry to the receiver’s
account
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Types of Receivers
 Pay-To Enrollees / Members
 Unassigned claim payments
 Disability payments
 Flexible Spending payments
 Billing Vendor
 Agent Commissions
 Capitation Providers
** EFT claim payments for providers via 835 process only
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Illustration of ACH Credit Flow
ODFI
Originator
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ACH Operator
RDFI
Receiver
EFT Workflow
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EFT Process
 Pre-notification (pre-note) sent through ACH network
 Non-dollar entry
 Alert RDFI of future live dollar transactions
 Verification of Receiver’s account number
 14-day “quiet” period
 Allows for acceptance/rejection of pre-note by RDFI
 Paper checks will continue to be generated
 Direct Deposit eligibility begins
 Pre-arranged Payment and Deposit Entry (PPD)
 ACH Credits only – voids/refunds will not be processed
electronically
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Copyright © 2014 TriZetto Corporation
EFT Processing Workflow
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Setup
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Checking Account Maintenance (SB)
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Checking Account Number
Line 16 – ABA Routing Number
Line 17 – EFT Trace Number
Line 22 – EFT Payment Method to ACH
Four new display-only EFT processing fields
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File Create Date
File Create Time
File ID Modifier
Batch Number
Copyright © 2014 TriZetto Corporation
Checking Account Maintenance (SB)
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EFT Participant Maintenance (EFTPM)
 Create EFT receiver information
 Member / Provider / Vendor
 Bank information
 RDFI routing number
 Account number / Account type
 System date range-based revision levels
 Financial institution changes
 Pre-note information
 One-to-many source financial institution (ODFI) records
 ODFI routing numbers and account numbers
 Date pre-note sent for each ODFI
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EFTPM – Member Record
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EFTPM – View Records
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EFTPM Deletion Rules
 Multiple future date ranges can be deleted
 Gaps in date ranges allowed
 Records where system date is greater than or
equal to Effective From date cannot be deleted
 Audit trail
 Anti-fraud measure
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Pre-Note Processing
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EFT Pre-Note Processor
 Generate EFT pre-notification authorization records
 One-to-many ODFI-specific records
 Check group/bank account driven
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Group Revision Maintenance (GR)
Plan Benefit Overlay (Plan Builder PPO / GBO)
Flex Control Maintenance (FSGM)
Disability Group Revision Maintenance (JGRM)
HMO Revision Maintenance (HMR)
Billing Commission/Fund Maintenance (BCFM)
Billing Installation Maintenance (BIM)
 Process only when new EFTPM records are created
 Cannot be run concurrently with EFT File Create
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EFTPNP
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EFTPM After EFTPNP
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EFT Processing
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EFT File Create
 Creates output files to communicate
 Pre-notification authorization records
 Electronic fund transfer payment records
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Output based on NACHA ACH Format
Separate output file for each ODFI
Printable summary report
Maximum number of 36 output files per ODFI per
system date
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AGPMAIN
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EFT File Create (EFTFC)
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EFTFC File Naming Conventions
 Dynamically named output files
 Each output file name begins with ACH
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ODFI Routing Number
Year (CCYY format)
Ordinal Date
File ID Modifier
 ACH1234567892013213A
 Represents an output file created on August 1, 2013 for
Routing Number 123456789 and File ID Modifier A
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EFTPM After EFTFC
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EFT File
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Sample EFT Output in NACHA ACH format
101 200706061 20070606110071219010094101
5220Pete Foskaris - 000000000001
1360000000PPDCLAIM PMNT
0000000001200706060000001
62345454545495415985641859854000000000 0001856200
0200706068464433
62345454545495415985641859854000000000 0001856200
0200706068464434
62345454545495415985641859854000000000 0001856200
0200706068464435
623985416528965410569851
000000000 0004686200
0200706068464436
623985416528965410569851
000000000 0004686200
0200706068464437
623985416528965410569851
000000000 0004686200
0200706068464438
62312345678998765432101234567000000000 0004712200
0200706068464439
62312345678998765432101234567000000000 0004712200
0200706068464440
62312345678998765432101234567000000000 0004712200
0200706068464441
822000000904690256250000000000000000000000001360000000
200706060000001
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9000001000001000009 0469025625000000000000000000000000
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ACH File Format
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ACH File Format
File Header Record
Company/Batch Header Record
Entry Detail Records
Company/Batch Control Record
Company/Batch Header Record
Entry Detail Records
Company/Batch Control Record
File Control Record
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File Header Record Contents
 Immediate Destination – SB Line 16 Routing
Number
 Immediate Origin – SB Line 16 Routing Number
 File Creation Date – Store date in new SB field
 File Creation Time – Store time in new SB field
 File ID Modifier – Store in new SB Field
 Permits multiple file created on same date and participants
 Store last used by date
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Company/Batch Header Record Contents
 Company Name – SN-1 Line 01 Name
 Company Discretionary Data – SB Account Number
(ODFI)
 Company Identification – SN-1 Line 06 Federal ID
 Company Entry Description (based on ck type)
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CLAIM PMNT (A – EFT claim ck, O – EFT enrollee voucher ck)
AGENT COMM (Z – EFT billing commission check)
CAPITATION (U – EFT capitation check)
FLEX SPNDG (X – EFT flex check)
 ODFI Identification – SB Line 16 Routing Number
 First 8 characters only
 Batch Number – Store in new SB field
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Entry Detail Record (PPD) Contents
 RDFI Identification – Routing Number for
receiver’s financial institution
 RDFI Account Number – Account Number for
receiver
 Amount – EFT check amount
 Nochk and nopay records/amounts will not be written
 Individual Identification Number
 Enrollee internal sequence number and employer group ID
 Vendor internal sequence number
 Provider internal sequence number
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Entry Detail Record (PPD) Contents (cont’d)
 Individual Name – Payee Last Name
 EDM (if applicable), otherwise EM
 PM Line 03 (if applicable) otherwise Line 01
 BVM Line 01
 Trace Number
 Sequentially updated by ODFI Routing Number
 Last Trace Number used will be stored in new SB field
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Company/Batch Control Record Contents
 Entry Count – Total of all PPD Entry Detail
Records
 Total Credit Entry Dollar Amount
 Company Identification – SN-1 Line 06 Federal ID
 ODFI Identification – SB Line 16 Routing Number
 First 8 characters only
 Batch Number – Store in new SB field
 Sequentially assigned
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File Control Record Contents
 Batch Count
 Total number of Company/Batch header records
 Entry Count
 Total number of all Entry Detail Records
 Total Credit Amount
 Total of Credit Entry Detail Records dollar amounts
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NACHA ACH Rules Information
 Basic online access
 Requires user self-registration
 http://www.achrulesonline.org/index.aspx
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Copyright © 2014 TriZetto Corporation
Workshop Survey
We would like to extend you an opportunity
to provide candid feedback.
During the workshop you should have received an e-mail
notification for you to take an on-line survey.
If you could take a few minutes to complete at this time ,
we would greatly value your feedback. For your convenience,
the survey will be available throughout the remainder of the conference
should you not be able to complete immediately.
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Thank You!
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